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Monday, May 4, 2015

Maybe we're getting somewhere. The nation's almost unanimous rejection of the proposed Medicare co-payment has proved to be a blessing. It's obliged the replacement Health Minister, Sussan Ley, to go back to basics and find genuine savings.

It won't be long before we find out what effect the failure of last year's budget has had on this year's. Judging by most accounts, it won't a favourable one.

Badly burnt by the monumental misjudgments in his first attempt, Tony Abbott seems to have swung to the opposite extreme of doing little or nothing to tackle our medium-term budget deficit problem.

But Ley's more positive response – initiating a review of the Medicare benefits schedule, a review of primary health care, a focus on Medicare compliance and a tougher renegotiation of the government's contract with the chemists' union – is a more hopeful sign.

The nationwide rejection of last year's budget is a seminal event, not just in the potentially brief life of the Abbott government, but in the history of budget-making. The present generation of politicians will be making judgments and drawing conclusions that will affect their behaviour for years to come.

But there's just as much cause for the econocrats, economists and business lobby groups to be learning from this historic stuff-up.

The rule that bureaucrats' advice to their political masters remains confidential means we can never know how much that advice contributed to the budget's failure. It's possible all the dumb ideas and misjudgments came from the pollies and their private-office advisers – not forgetting the totally over-the-top advice from a commission of audit subcontracted to the Business Council – but I find it hard to believe the econocrats contributed nothing to the disaster.

With Abbott copying John Howard in making his first act the sacking of a range of department heads "to encourage the others", it's possible the econocrats' advice wasn't as fearless as it should have been.

If so, let's hope Coalition politicians have learnt their lesson. If you frighten the econocrats to the point where they say Yes, Minister then stand well back while you do yourself an injury, your bullyboy tactics have robbed you of the protection the public servants could have provided.

But I suspect part of the problem is that year upon year of departmental staff cuts perversely known as "efficiency dividends" have, in fact, rendered the public service less efficient by robbing it of the expertise needed to propose sensible, targeted, efficiency-enhancing cost savings.

Finance and Treasury no longer have the ability to identify those areas in a particular portfolio where savings could be made without loss of quality or unintended consequences, and nor does the department itself.

If so, governments and their advisers have got themselves into a vicious circle: successive efficiency dividends have removed their ability to come up with well-considered savings, so they're compelled to fall back on another round of efficiency-sapping efficiency dividends.

The most obvious lesson – one to be learnt not just by politicians but by all those who care about fiscal responsibility – is that if you manage to con the pollies into proposing blatantly unfair "reforms" you run a high risk of actually setting back the cause of reform.

If, for instance, you tell the punters a Medicare co-payment is unavoidable because health spending is growing "unsustainably", while forgetting to mention that you're paying too much for generic drugs and chemists' dispensing, as well as paying for medical procedures that are known not to work.

A corollary is that slugging the punters so as to avoid fights with powerful drug companies, chemists' unions and doctors' unions is dumb politics.

The less obvious lesson is that the 2014 budget failed partly because the savings measures it proposed were such poor quality. So primitive, short-sighted and otherwise ill-considered. They were kneejerk cuts to which little thought had been given or expertise applied.

Don't try to reduce the element of waste and rent-seeking in health spending, just shift some of the cost onto patients, rich and poor alike, using some pseudo-economic excuse about the need for a "price signal".

Don't ask how many of the patients you deter from visiting doctors should have sought early advice or whether they'll end up costing taxpayers more than they would have. Worry about that in another budget – and fix it by increasing the co-payment.

Too many of the measures in last year's budget seem to have been proposed by accountants who understood nothing but the budget arithmetic and didn't care what crazy things were done to get back to surplus.

Let's hope Ley's more intelligent approach is a sign these lessons are being learnt.